![]() ![]() 3, 12- 20 The causative arterial lesions and vascular pathology were only occasionally discussed. Reports of the classic brainstem syndromes during the 19th and early 20th centuries were stimulated by fascination with brainstem anatomy and functions. 2- 11 We now report the frequency of various infarct locations, stroke mechanisms, clinical findings, vascular lesions, and outcomes in consecutive patients. The 407 NEMC-PCR patients serve as the data base for this and other reports. We collected the data in a prospective computerized registry. From 1988~1996, at the New England Medical Center (NEMC), we thoroughly evaluated all posterior circulation ischemia patients using brain imaging and vascular studies at first angiography and later magnetic resonance angiography (MRA), extracranial and transcranial ultrasound (TCD), and appropriate cardiac and hematological investigations. The lack of treatment options contributed to disinterest in vascular evaluation of patients with suspected vertebro-basilar disease. Inability to safely and quickly define causative vascular lesions limited therapy. Precise definition of brain lesions was not possible before magnetic resonance imaging (MRI). Keywords: Brain ischemia, Brain embolism, Posterior circulation, Vertebral arteries, Basilar arteryīefore the mid-1980s, posterior circulation brain and vascular imaging required catheter angiography and computed tomogram (CT). Embolic stroke mechanism, distal territory location, and basilar artery occlusive disease conveyed the worst prognosis. Most distal territory infarcts were attributable to embolism. Infarcts that included the distal territory were twice as common as those that included the proximal or middle territories. Infarcts most often included the distal posterior circulation territory (rostral brainstem, superior cerebellum and occipital and temporal lobes), while the proximal (medulla and posterior inferior cerebellum) and middle (pons and anterior inferior cerebellum) territories were equally involved. Stroke mechanisms in the posterior and anterior circulation are very similar. In 32%, large artery occlusive lesions caused hemodynamic brain infarction. Embolism was the commonest stroke mechanism accounting for 40% of cases (24% cardiac origin, 14% arterial origin, 2% had potential cardiac and arterial sources). Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs before strokes, and 16% had only posterior circulation TIAs.
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